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Cupping Therapy - Part Two

by Ilkay Chirali

6. Moxa Cupping Method (hot needle) - Ai Guan Fa (tonifying)

Moxa (Artemisia Vulgaris) is a great warming herb used by many practitioners for removing Cold and tonifying Qi and Blood. It usually comes in two forms, the loose type and the round, long, cigar shape. It is the latter type which is used during this treatment. Hot needle cupping is used where Cold patterns are predominant with pain. Here, acupuncture is used to move the channels, open the obstruction, and relieve pain. Moxa is used to heat the needle and transfer the heat to the acupuncture point in order to warm and tonify. This method is particularly useful in the treatment of Cold Bi patterns and arthritic joint pains.

This technique requires a great deal of care and patience. Inset a 1.5 inch long needle into the desired acupoints, cut about 1 inch of moxa roll, and insert it on the coil of the needle. Place a small piece of paper under the needle and on top of the skin, providing protection from ash falling from a burning moxa. Light the moxa and wait until it burns out completely. This might take up to 10 minutes. At this stage, when the Moxa is completely burnt out, the ash on top of the needle is cold or just warm. The needle however, remains hot for a considerable length of time. Without touching the needle or the ash, apply the cup over the needle (the same therapeutic effect can be achieved if the ash is tapped-off the needle while retaining the needle in place). When the desired cupping time is over, remove the cup gently and, before removing the needle, shake off the ash by holding a tray under the needle and tapping gently on its base. Hot needle cupping is especially beneficial in the treatment of Cold patterns of the Spleen and Stomach and lower backache caused by Kidney Yang Deficiencies and Cold, i.e. bed wetting or impotence. This method of treatment is not suitable for children under the age of 14 years.

7. Empty (Flash) Cupping Method - Shan Guan Fa (tonifying)

Empty cupping is also called flash cupping for its quickness of application. This method is actually a medium to strong cupping method, but is applied rapidly and the cups remain in place for a very short time, i.e. less than a minute. It is used for stimulating and moving the Qi and Blood on the weak and frail. The rather short duration of cupping application is enough to stimulate the Qi and Blood, but not enough to drain. It is therefore a tonifying method, particularly when Cold or Heat is the pathogenic factor in the weak, and frail and in children under 14 years old.

The technique is simple. Empty cupping is applied on the back of the body. Oil the area to be cupped, place up to 12 cups near at hand, light a large cotton wool ball and apply the cups simultaneously. Once all the cups are in place, start removing the cups without delay, beginning with the first cup applied. When all the cups are removed, reapply them to different positions immediately. This can be repeated for between five and ten minutes. A slight bruising will appear all over the back, but it will fade away within a day or two. This is the favourite cupping method for children.

8. Full (bleeding) Cupping Method - Xue Guan Fa (draining)

Also called wet cupping, this was the most favoured and practised cupping method of all by the early practitioners. Early medical practitioners, particularly in Europe, employed the bleeding cupping technique in order to purge foul blood from the body, which was considered the source of disease.

Today the bleeding method is used in the treatment of a sudden increase of blood pressure, and in the discharging of puss from boils and furuncles, which represent as an Excess, with Blood-Heat and stagnation. From this description, it can be seen that this method will only be suitable for adults with strong, Excess (Shi) patterns. This technique is not suitable for children or the elderly. The empirical point to bleed is Dazhui (DU 14), located on the first thoracic vertebra. Have the patient sit backwards on a chair, resting and supporting their head on a pillow in front of them. Sterilise the Dazhui (DU 14) point with alcohol and make a very small incision (0,5 cm) with a sharp razor or use a Plum-Blossom needle. Firmly tap the point for a short time to cause bleeding (I normally use the Plum-Blossom needle). Once the point is bled, choose a large cup size 4 or 5, and apply a strong cupping method to the point. The blood will be drawn slowly into the cup (figure 2). If the incision made was sufficient, between 30-60 ml of blood can be expected to be drawn into the cup. However, if the patient is taking any anticoagulant drugs, more blood may be drawn into the cup. Removing the cup full of blood requires special attention and care. Refrain from rushing, as it may cause the blood to spill from the cup. Within 15 minutes the bleeding will stop. Most of the blood drawn into the cup will be semi-coagulated, and therefore, still fluid. Before removing the cup, the practitioner should wear disposable surgical gloves on both hands, providing protection from direct contact with the blood. Ask the patient to sit upright, place a large paper towel under the cup with one hand. While pressing the upper edge of the cup with the other, remove the cup in an upright motion, making sure that the mouth of the cup remains covered with the paper towel at all times during this removal process. The cup is then cleaned by sterilizing it in Milton solution whilst the blood is disposed of in a clinical waste container. It is not recommended to bleed more than once a month and not more than 100ml at any one time.

Figure 2. Bleeding Cupping.

9. Herbal Cupping Method (Yao Guan Fa) (tonifying)

When employing this method, you require a few bamboo cups, a relatively deep pan, water, metal clamps, some form of fire, and herbs in a prescription based on the patient’s treatment plan. Put the herbs and the bamboo cups into a deep pan and cover them with water (glass cups become too hot and are therefore not suitable for this method). Bring the water containing the herb concoction and bamboo cups to boiling point, and simmer for 30 minutes. Prepare the patient in the normal way, and expose the part of the body to be cupped. When practitioner and patient are both ready, lift one cup at a time out of the pan with a metal clamp. Wait briefly to ensure that the cup is not too hot, and then apply the cup in the normal way. Once again, extra caution must be observed not to cause burns or blisters with hot cups or hot water dripping over the skin. The best precaution is to try the cups on your own skin before applying them to your patient. The herbs are soaked and absorbed by the bamboo cups, and in turn transfer their healing properties to the patient. This method is usually employed when external pathogens such as Cold, Damp and Wind attack the body, causing stiffness and aching of the body particularly the neck and shoulders (common cold, asthma, and a cough). While this treatment is not recommended for children under the age of 16 years old, it is particularly beneficial for the elderly and the frail with Qi and Blood Xu. I personally do not practice this method often as it requires a long period of time to prepare and administer and is therefore not very practical in a busy clinic. Cups can be left on between 10/20 minutes. Afterwards, the bamboo cups are infused in a herbal mix and boiled together to neutralise them.

10. Water Cupping (Shui Guan Fa) (even method)

This is one of the most least used and practised cupping methods. Firstly the practitioner needs to be experienced and fast during the application of this particular method, and secondly, it can be quite messy if not done correctly.

This technique involves filling a third of a glass or bamboo cup with warm water, and applying the cupping process in a quick fashion. Whilst holding the cup close to the patient with one hand, bring it close to the point to be cupped and insert the burning cotton wool into the cup, then swiftly and simultaneously turn the cup onto the skin. When performed properly, no water spillage occurs. If the application is performed in a slow motion some water spillage over the patient is inevitable. This should however present no problems, as the water used is only warm and will cause no harm. This method of cupping disperses the inhibited Lung-Qi, regulates the Lung-Qi and resolves Phlegm, based upon the Lung’s influence of body fluids (Chirali 1999). It is especially beneficial for asthma sufferers, as well as Wind-Cold or Wind-Damp rheumatic conditions, localised swellings and pain. It is said to be particularly beneficial in the treatment of asthmatic conditions in children when used on Feishu (UB 13). Usually a bruise does not appear with this method.

Cupping on Children

I have treated children with acupuncture and cupping from the very first week of opening my practice in Melbourne, Australia. However, it wasn’t until I studied paediatric acupuncture with Julian Scott in England, who is a prominent acupuncturist and a teacher on the subject, that I discovered the full potential of Chinese medicine in the management and treatment of children’s diseases.

Children in general respond well and do not mind cupping therapy. They certainly prefer it to acupuncture treatment! Children under the age of 7, require just a little extra care and patience during treatment. At this age children are quite unpredictable, one minute appearing quite calm and relaxed, and the next, with little warning, they can turn quite the opposite; weepy, angry and restless. It should also be remembered that the skin of a child of this age is extremely sensitive and vulnerable. I would certainly not recommend any method of cupping applied to children under the age of 4 years old. It is also worth bearing in mind that some children are petrified of fire.

Before a cupping treatment proceeds, the accompanying parent should be given a full explanation of the cupping procedure as part of the co-operation necessary between parent and practitioner. If necessary, apply a small cup to the inside of the parent’s arm, and let the child touch and feel the cup. Distraction of any kind by the parent will help to relax the child, inspire confidence and take away the child’s attention from the practitioner during the application.

Small size cups (size 1 - 2) are most suitable for children under 7 years old, also size 2 and 3 cups can be used for children under 14 years old. The golden rule to follow when treating children under 7 years old is that the maximum treatment time allowed is just 5 minutes, and between 7 and 14, a maximum of 10 minutes. The strength of the cups should only be empty, weak or medium. Never use strong, moving, needle, moxa or full methods on children under the age of 14. Children also bruise and blister easily, and a close watch is constantly needed at all times. A gentle massage after the cupping treatment will take away the apprehension and relax the child, and at the same time build a good rapport with the child for future treatments. In China, cupping treatment is employed daily, and ten treatments constitute a single course. In the West however, like acupuncture, a treatment once a week is the normal frequency.

The most common children’s ailments treated by cupping therapy include, asthma, common cold, and digestive complaints. Usually the Back Shu points are cupped. For a more comprehensive study on children’s treatment with Chinese medicine, see J. Scott 1991 Acupuncture in the Treatment of Children.


Ilkay Chirali qualified as a TCM practitioner in 1985 in Melbourne, Australia where he opened his first clinic. He later returned to England in 1987 where he set up his own clinic in South East London and is still practicing. He has presented numerous papers on cupping at five international seminars and held well over 40 cupping therapy workshops as well appearing as an ‘expert’ on BBC TV and radio programmes. For details of forthcoming cupping workshops, contact Ilkay Chirali via email:


Chirali, I. (1999). Traditional Chinese Medicine Cupping Therapy. Edinburgh: Churchill Livingstone.

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